Are e good citizens?...Health care .. We are to blame

Dear friends. I thought I will begin my contribution to the lively dicussion by re- addressing the issues of health services.in Sudan. We have discussed that in our medics list, there were good talk, but as usuall, it is just talk. I still beleive, in a third class country like ours, where deocracy in its full meaning, that is to say, accountability to the people's representatives, is a big problem. I was particularly impressed by the response from my friend, Dr Madani Omer( Wooster Agricultural College, Ohio state) .He kindly reviewed the contributions, and came out with an opinio, that the problem is wider, It is all of us, sudanese, . Once we reach a position of power, we tend to forget the problems of Mohammed Ahmed.
I will begin by posting my trouble some experience when I last visited my home town Atbara, and later on I will repost Dr Madani'e comments. Thanks

When I see my fellow doctors talking about patient mortality and
morbidity in Khartoum Teaching Hospitals, I frequently ask my self, what
are they talking about?. We have no respect for pateints in sudan!?!?!!. We
have respects for their important relatives who are either our friends,
relatives, or our local VIPS ...etc... In fact we have no respect to the
human being as such if you look deeply into the matter. When I was a
medical student, I saw a doctor, upon the insistance of a patient to review
his X rays for him, he grabbed the films from him in a hysterical manner,
throw them to the floor, and crushed them with his newly polished shoes,
and ordered him to leave the office immediately. I didn't believe King
Henry the VIIIth would do that to his poorest of subjects.
The last time I visited my local town, our neighbor's wife gave birth
to a not very premature baby (1900grams) at home. The little baby started
having seizures few ours after birth. His father came rushing to our house
asking for help. I told him: your baby needs to be seen in the emergency
room for a likely hospital admission. That was a 3.00 PM. At 7.00 PM Their
little daughter came out running. Her newly born brother is seizing again.
I asked his father: For God's sake, why is your child still in the house?.
He told me: You don't know how things are run around here. We waited until
the private clinics open at 5:30 evening for the pediatrician to see him in
his private clinic, if we were to insure quick action> (this is how locals
trust the health system) They went to see the pediatrician who was away on
vacation. His Medical officer was covering for him. He told the Dad: your
son has Malaria,. He sent the baby home on chloroquine. An hour later, the
baby started seizing again. This time I went with them. to the ER ( one
junior newly graduated houseman is residing in the ER. At the same time, he
is the sole lone doctor in charge of all the hospital inpatients in this
alleged Regional Hospital. The young doctor listened to what I have to say
and ordered admission to the pediatric floor. There is no receiving doctor
at the other end. The only nurse available had the honor of occupying the
only sheet-covered bed in the ward. Her bed is situated in a strategic
place, under a large tree , about five minutes walking distance from the
second floor where the poor child is to be admitted. His father brought his
bed sheets with him from home. ( common practice, are you kidding? he said.
When I saw the huge floor(originally built by the railway engineers as a
gift to the hospital, two fans running fully, single large sink full to its
mouth and nose with dirty water, five or six beds scattered around, old
mattresses, some old and torn, some with urine making geographic maps, no
bed sheets in site. Depressing, isn't it?. The father and the Haboba layed
out the sheets. I layed out my plan to the nurse> IV line, IV fluids, IV
antibiotics, Basic stuff. You must be kidding. She is not prepared for
that. Plastic syringes re-boiled several times. Penicillin is the only
thing available. You don't have little rooms for such tiny kids?, Where is
your weighing scale? ( the only weighing scale available is in the medical
directors office (closed after five). Are you going to take his vital
signs? How are you intending to visit him if your nursing station (the bed
under the tree) is miles away?. I tried my best not to be offensive( you
know the consequences for sure). CBC, Electrolytes, Septic work up for that
baby?!, imaging studies!? this is luxury,don't dream. I told the haboba
what to do, if he seized again or if he does any thing unusual. Monitoring
?, Isolette? I read your mind, don't offend me. At seven am next day, tears
were dripping silently from his father's eyes. They lost their crown
prince. Late the night before, the baby started seizing. The haboba rushed
down the stairs to alert the nurse. She was sound asleep. Better have a
good night sleep before she goes for her other job in the morning. Yes, she
works two jobs. She has her own problems, you know. The nurse came to see
her patient more than half an hour later. He was already in heaven. I told
you doctor, the father said. There is no use in taking him to the hospital.
The haboba was giving the ant-malarial with a spoon. He can't suck. I told
you he is a sick premie.
One week later, my diabetic uncle refused to eat. His enthusiastic
daughter kept giving him his oral hypoglycemic in time. She puts all kinds
of foods in front of him and goes to her school. The whole block was
awakened at 3.00 am with the crying of his wife and children. He is in
coma. They thought he is on his last hours. The whole city was in black
out. Except in the affluent elite part. Their lights are always there. You
can count on that. The hospital is rapped with darkness. The moon is
absent. We drove him to the ER. There is no direct access road by car to
the entrance. New buildings are raised around it. We asked for stretcher.
The only available one was taken hours ago to transfer a dead patient home.
The hospital is completely in dark except for our torches. The only nurse
is sleeping in a near by room. The young doctor is sleeping too in another
room. He seems articulate. What can he do?. Is the hospital theatre working
at this time? do you have lights there?. What happens if you have a
surgical emergency?.. The generator is not working. The doctor ordered
prescriptions for IV fluids. The patient's son went to the hospital
pharmacy across the corridor. He has to be first , yes, believe it. The
pharmacy is in complete darkness. a large table in the middle of the room.
a nicely sheeted mattress on top of it. The young pharmacy assistant is way
asleep on top of the mattress on top of the table. We gave him our torch
and our money to get the medications. The nurse is trying hard to get a
vein on this dehydrated atherosclerotic body. No mediswabs, please don't
offend me. He tried his large-pored needle several times before he
succeeded Glucometer? (it cost 50 Pound Sterling, $100?). The blood sugar
result showed up at 1 PM the next day. Yes, my uncle lived to see the
result). Electrolytes?. You have to take the blood sample to a private lab
tech. across the street to get them done. The respected Pathologist who
came to town and worked hard to establish a regional pathology lab. was
transferred to another city, as requested by the local authorities, after
several imprisonments for his believes. This is a regional hospital in a
major city. not in um-bukol or shalaoha ########da. I am sure many of us
have many sad stories to tell. Is it a problem of funds or economic
hardships?, or rather lack of respect for the fellow humans? what is going
on there far south, north, east and west of Khartoum is a forgotten world.
Kulo sanna wa into Taibeen
A. Abdalla

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e failed our fellow citizens and settled in the soW
called civilized world and left them to their miseries. I salute our
colleagues who are fighting in the front line and doing what they can to
combat poverty and various endemic disease. However, That is not an excuse
for:
A doctor to humiliate his patients in the manner I described
A nurse to leave her patient's bed side and have a comfortable night sleep
while on duty
A hospital administrator not to provide clean bed sheets and mattresses to
the inpatients
A regional hospital not to be exempted from the frequent electricity
blackouts that became the norm through out the Sudan
A hospital administration that does not give priority to a better equipped
ER.
(Patient in coma brought by his family, no stretchers, he was carried by
four(Arbaa Minno, relatives has to pay for the emergency therapy before he
can be treated?????, no emergency plans for electricity black outs( we gave
our torches to the nurse, doctor and pharmacist). and so I could go on and
on for ever.
I am not blaming the doctors, specially the newly graduated young ones, I
am blaming the insensitivity, the system, the indifference. What can I say
?. Perhaps a time will come when we all go back there and work for a better
service. Stay well.
Abdalla
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And more....
I am still waiting to hear that we have installed oxygen supply on the walls of ER rooms, we have facilities to deliver ventolin nebulizer machines in all ER rooms, we have CP monitors , pulse oxometers, glucometrers, We have all the necessary IV fluids, canulas, surgical trays etc..., readily available for use without the patient's families paying first. I am still hoping that we will have proper hospital patients records with contact addresses and telephone numbers to facilitate proper health care. An asthmatic patient came to one of those regional hospitals in severe distress. He ran out of his ventolin inhaler. Probably they gave him Aminophyline and that was it. The town pharmacies ran out of ventolin aerosols. While in hospital ER, the family ran an add in the local TV station, yes, this is a city with its own TV station, requesting the good samaritans for help. An enthusiastic asthmatic (Wad Gabila) from the outskirts of the city, rode his bicycle with his only ventolin inhaler dangling in his Arragi. By the time he reached the hospital, the patient had already left home. He continued his un relentless journey to the local TV station, in case he finds the address of that patient. It was dark as usual. The TV station already closed its gates for the day. He rode on back home disappointed and equally distressed. This time he too needs his inhaler. This is a true story without fabrication. It is good to hear something is happening in Khartoum. How about the forgotten world around?. Abdalla

Dear Abdalla,
Thanks a lot for the messages. I read with great interest and pleasure your
exchange with your fellow doctors. It is so sad and depressing to realize
the short change our Sudanese people (nas Mohamed Ahmed Alagbush Alaseel)
always receive from the power to be. This power to be could be the medical
doctor, the clerk in the post office, the receptionist at any office, the
customs officer as you enter Khartoum air port, the guard at the hospital
gate, the conductor or komsari on you bus or hafila, and the list goes
on..and on..and on. What depresses me the most is that there is no reason
for this treatment or lack of respect for the human being as you elegantly
called it. We -by our very nature as many non Sudanese could attest to
that- are very pleasant people. How could a person explain your going out
of your way to help a stranger that you never met before and walk with him
may be for miles to direct him to somebody's house!? How could we explain
getting up in the middle of the night to a company a ginaza -of a person
who lives 10 blocks away from where you live- to the graveyard!? How could
you explain your travelling for hours may be for days to attend your
friend's brother wedding?! How could you explain as our great poet Isameen
Hassan said "nihna helefta mudfoo"!? However, from that same person who
will do all these things and more, it will be next to impossible to crack a
smile on his face if you drop by his office or hospital for a service that
is rightfully yours as a SUGDANI. Maybe it is that when some of us smell a
very remote sense of power they act as if as they are Gods!! I guess this
medresat algaba wa assahra (the Forest and the Desert) is really killing
our souls just like that guy if you read Kamus' or was it Kafka's "The
Stranger". Our souls are a mixture of that of a herdsman (for whom
civilization is not even a word in his vocabulary) and a gentle farmer who
wants to give back to the society what the land has generously given to
him, so that he will get more from it next season. We are
really..really..messed up my friend!! Our PR attitude is nill. As somebody
mentioned in the messages we need to include PR and civility in
our curriculum. So that the new generations will learn how to treat each
other with respect and dignity.
Well, my dear it is a long story and it is close to 7:00 pm and I am
getting tired and hungry. So let me close by saying may be Linda, Hassan.
Mehedi, Asim, Mohamed, Ahmed, Shiraz, Fatima, Omer, Ali, Mazin, and the
rest of aligd alfreed will be better citizens of the world. Amen.
Salam to all
Medani

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